Laser and Face Peel Procedures in Non-Caucasians

Chemical peels for acne vulgaris: a systematic review of randomised controlled trials

OBJECTIVE

We evaluated current evidence from randomised controlled trials (RCTs) regarding the effectiveness of chemical peeling for treating acne vulgaris.

METHODS

Standard Cochrane methodological procedures were used. We searched MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE via OvidSP through April 2017. Reviewers independently assessed eligibility, risk of bias and extracted data.

RESULTS

Twelve RCTs (387 participants) were included. Effectiveness was not significantly different: trichloroacetic acid versus salicylic acid (SA) (percentage of total improvement: risk ratio (RR) 0.89; 95% CI 0.73 to 1.10), glycolic acid (GA) versus amino fruit acid (the reduction of inflammatory lesions: mean difference (MD), 0.20; 95% CI -3.03 to 3.43), SA versus pyruvic acid (excellent or good improvement: RR 1.11; 95% CI 0.73 to 1.69), GA versus SA (good or fair improvement: RR 1.00; 95% CI 0.85 to 1.18), GA versus Jessner's solution (JS) (self-reported improvements: RR 1.00; 95% CI 0.44 to 2.26), and lipohydroxy acid versus SA (reduction of non-inflammatory lesions: 55.6%vs48.5%, p=0.878). Combined SA and mandelic acid peeling was superior to GA peeling (percentage of improvement in total acne score: 85.3%vs68.5%, p<0.001). GA peeling was superior to placebo (excellent or good improvement: RR 2.30; 95% CI 1.40 to 3.77). SA peeling may be superior to JS peeling for comedones (reduction of comedones: 53.4%vs26.3%, p=0.001) but less effective than phototherapy for pustules (number of pustules: MD -7.00; 95% CI -10.84 to -3.16).

LIMITATIONS

The methodological quality of the included RCTs was very low to moderate. Meta-analysis was not possible due to the significant clinical heterogeneity across studies.

CONCLUSION

Commonly used chemical peels appear to be similarly effective for mild-to-moderate acne vulgaris and well tolerated. However, based on current limited evidence, a robust conclusion cannot be drawn regarding any definitive superiority or equality among the currently used chemical peels. Well-designed RCTs are needed to identify optimal regimens.

Optimizing Postsurgical Scars: A Systematic Review on Best Practices in Preventative Scar Management

BACKGROUND

Scar management is critical for every plastic surgeon's practice and, ultimately, the patient's satisfaction with his or her aesthetic result. Despite the critical nature of this component of routine postoperative care, there has yet to be a comprehensive analysis of the available literature over the past decade to assess the best algorithmic approach to scar care. To this end, a systematic review of best practices in preventative scar management was conducted to elucidate the highest level of evidence available on this subject to date.

METHODS

A computerized MEDLINE search was performed for clinical studies addressing scar management. The resulting publications were screened randomized clinical trials that met the authors' specified inclusion/exclusion criteria.

RESULTS

This systematic review was performed in May of 2016. The initial search for the Medical Subject Headings term "cicatrix" and modifiers "therapy, radiotherapy, surgery, drug therapy, prevention, and control" yielded 13,101 initial articles. Applying the authors' inclusion/exclusion criteria resulted in 12 relevant articles. All included articles are randomized, controlled, clinical trials.

CONCLUSIONS

Optimal scar care requires taking into account factors such as incisional tension, anatomical location, and Fitzpatrick skin type. The authors present a streamlined algorithm for scar prophylaxis based on contemporary level I and II evidence to guide clinical practice.

Chemical Peels: Indications and Special Considerations for the Male Patient

BACKGROUND

Chemical peels are a mainstay of aesthetic medicine and an increasingly popular cosmetic procedure performed in men.

OBJECTIVE

To review the indications for chemical peels with an emphasis on performing this procedure in male patients.

MATERIALS AND METHODS

Review of the English PubMed/MEDLINE literature and specialty texts in cosmetic dermatology, oculoplastic, and facial aesthetic surgery regarding sex-specific use of chemical peels in men.

RESULTS

Conditions treated successfully with chemical peels in men include acne vulgaris, acne scarring, rosacea, keratosis pilaris, melasma, actinic keratosis, photodamage, resurfacing of surgical reconstruction scars, and periorbital rejuvenation. Chemical peels are commonly combined with other nonsurgical cosmetic procedures to optimize results. Male patients may require a greater number of treatments or higher concentration of peeling agent due to increased sebaceous quality of skin and hair follicle density.

CONCLUSION

Chemical peels are a cost-effective and reliable treatment for a variety of aesthetic and medical skin conditions. Given the increasing demand for noninvasive cosmetic procedures among men, dermatologists should have an understanding of chemical peel applications and techniques to address the concerns of male patients.

Facial microcirculatory and biomechanical skin properties after single high energy (Er):YAG laser application

OBJECTIVE

Owing to skin aging and the growing demand for skin rejuvenation, minimal invasive aesthetic treatments such as laser procedures are increasingly coming into focus. However, until now, little has been known about the objective effects of these procedures with respect to skin microcirculation or changes in skin elasticity.

STUDY DESIGN

Facial skin rejuvenation was performed on 32 volunteers using ablative Erbium: YAG laser. Skin microcirculation and skin elasticity have then been evaluated objectively.

METHODS

Microcirculation (flow, SO₂ , velocity, and rHB) has been analyzed before and directly after the laser session by using the O2C device. Skin elasticity has been evaluated by using the Cutometer device (Uf, Ua, Ur, and Ue) before and directly after the laser treatment, as well as 1 week and then 1, 3, and 6 months post treatment. Further, the outcome for the volunteers regarding their satisfactory level after laser treatment was evaluated.

RESULTS

Twenty volunteers were available for a complete follow-up. Microcirculation displayed statistically significant increase in all values to 2 mm depth. The biomechanical skin parameter of firmness of skin displayed statistically significant improvement in superficial skin layer after 6 months.

CONCLUSION

Concerning microcirculation and skin elasticity the ablative Erbium: YAG laser treatment revealed similar effects on the skin like a superficial burn injury. In contrast to the determined skin elasticity parameters, firmness of skin objectively revealed a skin tightening effect after 6 months. Along with the important epidermal effect, the suitability of ablative laser treatment for skin rejuvenation has been proved in a long-term follow-up. Lasers Surg. Med. 49:891-898, 2017. © 2017 Wiley Periodicals, Inc.

Fundamental research on the action mechanism of the 800 nm semiconductor laser on skin blackheads and coarse pores

The aim of the study was to determine the mechanism of action of the 800 nm semiconductor laser on skin blackheads and coarse pores. A total of 24 healthy purebred short-haired male guinea pigs, weighing 350–400 g, were selected and smeared with 0.5 ml coal tar suspension evenly by injector once daily. Treatment was continued for 14 days to form an experimental area of 8×3 cm on the back of the guinea pigs. The animals were divided into the following groups: Normal control group (NC), low-dose laser treatment group (L-LS), high-dose laser treatment group (H-LS), and Q-switched Nd:YAG treatment group (QC). Samples were extracted 1, 7 and 14 days after surgery and hematoxylin and eosin staining was used to identify the following: Epidermis, dermis, sebaceous gland change and hair follicle damage; the expression of proliferating cell nuclear antigen (PCNA) of sebaceous gland cells using immunohistochemistry; sebaceous gland cell apoptosis using TUNEL; and the protein expression of caspase-3, Bax and Bcl-2 using western blot analysis. With the extension of time, we observed inflammatory cell infiltration, an increase in hair follicle distortion and necrosis of the surrounding hair follicles. The expression levels of PCNA of the L-LS, H-LS and QC groups decreased with time. Regarding the respective time points, the NC group was highest, the L-LS and H-LS groups were next highest and the H-LS group was lowest. The difference was statistically significant (P<0.05). The apoptotic rate of the L-LS, H-LS and QC groups increased with time. With regard to the respective time points, the NC group was lowest, the L-LS and QC groups were next lowest and the H-LS group was highest. The difference was statistically significant (P<0.05). The protein expression of caspase-3, Bax and Bcl-2 of the L-LS, H-LS and QC groups increased with time. Regarding the respective time points, caspase-3 and Bax protein expression of the NC group was lowest, the L-LS and QC groups were next lowest and the H-LS group was highest. Bcl-2 protein expression of the NC group was highest, protein expression of the NC group was next highest and the H-LS group was lowest. The difference was statistically significant (P<0.05). In conclusion, the low-dose 800 nm semiconductor laser is an effective treatment on skin blackheads and coarse pores, and promotes hair follicle cell apoptosis without reducing the expression of PCNA.